野芭蕉对经皮冠状动脉介入术CYP2C19基因中间代谢表型患者的疗效观察

Observation of the Therapeutic Effect of Wild Plantain on Patients with CYP2C19 Gene In-termediate Metabolic Phenotype during Percutaneous Coronary Intervention

摘要: 目的：探讨野芭蕉对CYP2C19基因中间代谢表型(IMP)患者的疗效及其机制。方法：选90例IMP患者，随机分为中药组和西药组，中药组用常量氯吡格雷 + 石斛野蕉处方治疗，西药组用双倍量氯吡格雷治疗，连用180 ± 10 D。比较两组患者血小板最大聚集率(MPAR)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、血尿酸(AU)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDLC)、极低密度脂蛋白胆固醇(vLDLC)、甘油三酯(TG)、再梗和出血水平。结果：中药组PMAR有效率高于西药组(P < 0.01)。中药组SBP、DBP、FBG、AU、TC、vLDLC和TG水平低于西药组(P < 0.01或P < 0.05)。随访 ≥ 6个月，中药组患者发生再梗1例，占2.2%，西药组发生再梗5例，占11.1%，发生出2例，占4.4%。两组患者再梗率、出血率比较，差异没有统计学意义(P > 0.05)。结论：野芭蕉可有效缓解中间代谢型患者血小板紊乱情况，减少经皮冠状动脉介入治疗患者出血和再梗死的发生率，其作用机制与降低患者的血压、血脂、血糖和血尿酸水平有关。

Abstract: Objective: To investigate the therapeutic effect and mechanism of wild plantain on patients with intermediate metabolic phenotype (IMP) of CYP2C19 gene. Methods: 90 patients with IMP were randomly divided into two groups: the Chinese Medicine Group and the Western medicine group. The Chinese medicine group was treated with clopidogrel and wild plantain of Dendrobium, while the western medicine group was treated with clopidogrel of double dosage for 180 ± 10 days. Max-imum platelet aggregation rate (MPAR), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), serum uric acid (AU), total cholesterol (TC), high-density lipo-protein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), low-density lipoprotein cho-lesterol (VLDLC), triglyceride cholesterol (TG), reinfarction and bleeding were compared between the two groups. Results: The effective rate of PMAR in Chinese medicine group was higher than that in Western medicine group (P < 0.01). The levels of SBP, DBP, FBG, Au, Tc, VLDLC and TG in the Chi-nese medicine group were lower than those in the Western Medicine Group (P < 0.01 or P < 0.05). After 6 months follow-up, 1 case (2.2%) in Chinese medicine group, 5 cases (11.1%) in Western medicine group and 2 cases (4.4%) in Western medicine group had reinfarction. There was no sig-nificant difference in reinfarction rate and bleeding rate between the two groups (P > 0.05). Conclu-sion: Wild plantain can effectively alleviate the platelet disorder in patients with intermediate me-tabolism type and reduce the incidence of bleeding and reinfarction in patients undergoing percu-taneous coronary intervention, the mechanism of action is related to the lowering of blood pressure, blood lipid, blood glucose and blood uric acid.